Lavage by laparoscopy fares better than lavage by laparotomy |
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Authors: | L Linhares H Jeanpierre F Borie A Fingerhut B Millat |
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Institution: | Surgical Unit, H pital St-Eloi, Montpellier, France. |
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Abstract: | Background: Although carbon dioxide (CO2) pneumoperitoneum is proposed increasingly for treatment of secondary peritonitis,
associated deleterious effects have been reported in experimental models, with the hypothesis that increased intraperitoneal
pressure might facilitate bacterial translocation. The purpose of this study was to compare the outcome (and qualitative microbiologic
analysis) from peritonitis in rats after lavage by laparoscopy with the outcome after lavage by laparotomy. Methods: After
determination of the standard innoculum for this study in 30 animals, 120 male Wistar rats received 1 ml of Escherichi coli
106 colony-forming unit (CFU), Bacteroides fragilis 107 CFU, Enterococcus faecalis 107 CFU in a sterile rat feces-barium sulfate
suspension adjuvant, were anesthetized with intramuscular ketamine, and then underwent peritoneal lavage by either laparotomy
(n = 60) or laparoscopy (n = 60). The duration of peritonitis defined two groups: group A: duration less than 3 h (n = 20)
and group B: duration 3 h or more (n = 40). Both groups underwent successive lavage with 10-ml aliquots (total, 50 ml) of
0.9% saline solution at 37°C. Five 2-ml samples of liquid lavage were drawn for culture and microbiologic analysis. Blood
(0.2 ml) and peritoneal liquid lavage samples were incubated 48 h at 37°C and cultured. Results: All the animals survived.
Mean duration of peritoneal lavage was 13.2 min (range, 6-25 min) for laparoscopy and 9.7 min (range, 6-15 min) and for laparotomy.
The difference was not statistically significant. The mean duration of operation was significantly longer with laparoscopy
than with laparotomy: 44.5 min (range, 35-62 min) and 25 min (range, 16-40 min), respectively (p = 0.0001). The collected
lavage volumes were not statistically different: 48.5 ml (range, 40-54 ml) and 46.7 ml (range, 37-56 ml), respectively. No
statistically significant differences were found between the laparoscopy and laparotomy groups in terms of E. coli bacteremia,
irrespective of peritonitis duration. The rates of positive blood culture for B. fragilis and E. faecalis were signficantly
lower after laparoscopy than after laparotomy, both in the overall group (p = 0.025 and p = 0.045, respectively) and when
duration of peritonitis exceeded 3 h (p = 0.001 and p = 0.044, respectively). Conclusions: In this animal model of secondary
peritonitis, lavage by laparoscopy was associated with less bacteremia for B. fragilis and E. faecalis than peritoneal lavage
by laparotomy. |
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